急性脑血管病与心电图改变的关系探讨

急性脑血管病常并发心脏损害,由于其病情危重,病死率高,因此令人关注。为了研究急性脑血管病与心电图异常的关系,笔者对我院2001年1月～2002年4月收治的320例急性脑血管病患者行头部CT扫描定性和定位,并行心电图及24h动态心电图检查,以分析急性脑血管病病变性质、部位、严重程度及其与心电图改变的相互关系。资料与方法一、一般资料320例患者,男174例,女146例;年龄32～77岁,平均52.5岁。其中脑出血140例(包括42例蛛网膜下腔出血,脑出血组),脑梗死180例(不包括腔隙性脑梗死,脑梗死组)。所有入选病例诊断均符合1995年第四届全国脑血管病学术…     

急性脑卒中患者异常宽大T波心电图的临床研究

目的分析急性脑卒中患者异常心电图与预后的相关性,以期为临床提供借鉴。方法回顾2009-06—2013-12入我院诊断为急性脑卒中患者为研究对象,分析患者心电图的变化情况及预后等数据,评价急性脑卒中患者异常宽大T波心电图与预后的相关性。结果 160患者,73例脑梗死,51例脑出血,36例蛛网膜下腔出血。存活118例,死亡42例。通过统计分析,死亡组与存活组在心率、ST段抬高、ST段压低、T波倒置、U波倒置、室性心律失常出现的频率无明显差异(P0.05);在出现异常Q波、室上性心律失常频率、异常宽大T波、心电图评分偏高时,格拉斯哥预后(GOS)评分明显偏低,差异有统计学意义(P0.05,通过多因素Logistic回归分析,异常Q波(OR=1.777,95%CI:0.347~3.741)、异常宽大T波(OR=2.850,95%CI:1.173~6.925)、室上性心律失常(OR=1.664,95%CI:1.433~2.020)是影响预后的影响因素。结论心电图异常急性脑卒中的病情和预后均有重要的指导意义,出现异常Q波、异常宽大T波、室上性心律失常,尤其异常宽大T波常提示病情危重及预后不良。     

急性脑血管病与心脏损伤关系探讨

目的探讨急性脑血管病与心脏损伤的关系。方法150例急性脑血管病患者发病后24h内行心电图检查及心肌酶谱检测。结果(1)150例急性脑血管病患者中有114例(76%)发生心电图异常改变;心肌酶谱异常106例(70.6%)。(2)不同性质的急性脑血管病患者心电图及心肌酶谱异常发生率无显著性差异(P0.05)。(3)不同部位的急性脑血管病患者心电图及心肌酶谱异常率存在显著差异(P0.05)。(4)发生意识障碍的急性脑血管病患者与无意识障碍的患者之间心电图与心肌酶谱异常率存在显著差异(P0.05)。结论急性脑血管病患者可引起心电图与心肌酶谱的异常改变,其与病变性质无关,而与病变部位和意识有关。     

急性脑血管意外并发消化道出血的观察与护理

急性脑血管病 (脑出血、脑血栓、脑栓塞和蛛网膜下腔出血 )常引起胃肠道黏膜急性糜烂 ,出血和溃疡形成 ,导致上消化道出血。这种胃肠病变出血量有时较大 ,不易自止 ,可迅速导致循环衰竭 ,使脑血管病症状更加恶化 ,预后不良。应及早诊断 ,妥善处理 ,其护理极为重要。现将我院急性脑血管意外并发消化道出血 60例分析如下。1　临床资料1 1　一般资料　病例入选标准 :全部病例均为住院患者 ,头颅CT证实为脑出血、脑梗死、蛛网膜下腔出血。 60例中男 3 8例 ,女 2 2例 ,年龄 3 6～ 78例 ,平均 5 7岁。脑出血 3 6例 ,脑梗死 19例 ,蛛网膜下腔出血 …     

急性脑血管病并发脑心综合征分析

目的探讨急性脑血管病(ACVD)患者并发脑心综合征时心电图变化和机制。方法分析428例ACVD患者常规12导联心电图结果。脑出血142例,脑梗死201例,蛛网膜下腔出血85例。结果 428例ACVD患者异常心电图382例(89.3%),表现为窦性心律失常(窦速、窦缓、窦律不齐)、房性心律失常(房早、房速、房颤)、室性心律失常(室早、室速)、传导阻滞(房室阻滞、束支阻滞),电解质紊乱(低钾),ST段、T波及U波改变,心肌梗死。ACVD心电图改变呈一过性、暂时性,并随病情恢复而好转。结论 ACVD患者应及时并跟踪检查心电图,必要时检查24hholter,可全面掌握脑心综合征所致心肌损害程度,充分认识其危害性并积极干预,能有效降低患者病死率。     

急性脑血管病并发癫（癎）的临床研究

目的 研究急性脑血管病并发癫（癎）的发病机制、疾病特征、治疗与预后.方法 选取2008-01-2011-12我院862例急性脑血管病患者,其中并发癫（癎）患者73例,给予正规原发疾病的治疗以及相应抗癫（癎）治疗,比较分析急性脑血管病并发癫（癎）的发病率、发作类型、发作时间、病死率等.结果 急性脑血管病并发癫（癎）的发病率为8.47%,其中脑梗死占8.03%（37/461）,脑出血占9.87 %（22/223）,蛛网膜下腔出血占9.86%（14/142）;单纯部分性发作病例比例最高（P〈0.05）;急性脑血管病并发癫（癎）患者中早期发作型癫（癎）比例较高;脑出血和蛛网膜下腔出血的患者更易并发早期发作型癫（癎）（P〈0.05）,而脑梗死的患者更容易并发迟发型癫（癎）（P〈0.05）;急性脑血管病并发癫（癎）患者总病死率为36.99%,明显高于未并发癫（癎）患者（P〈0.05）.结论 急性脑血管病并发癫（癎）的发病率为8.47%,以早期发作型癫（癎）比例较高,且病死率较高.     

急性脑血管病30例异常心电图分析

自1974年Byer首次报告脑血管病的心电图改变以来，急性脑血管病常出现心电图异常改变一直为人们所关注。本文对急性脑血管病的心电图异常进行前瞻性研究，探讨其对判断预后的价值及临床处理。本文总结了我院1993年11月～1998年12月资料完整的急性脑血管病人50例心电图改变，并讨论其发病机理及临床意义。1临床资料1．1一般资料本组50例男34例，女16例。年龄32～75岁平均56．6岁。系我院1993年11～1998年12月住院病冽，均经临床及CT确诊。其中脑出血30例，脑梗死13例，蛛网膜下腔出血7例。均在入院后常规做12导联心电图检查并与入院前心电…     

急性脑血管病后癫痫发作

目的:研究急性脑血管病后癫痫发作的发生率、发作时间及类型、有关因素及对预后的影响。方法:除外引起癫痫的其他脑部和代谢障碍疾病后,并除外短暂性脑缺血发作和多发性脑梗塞后,每例均经头部CT或MRI证实的急性脑血管病住院患者,随访其癫痫发作的情况。结果:本研究包括急性脑血管病患者1044例,癫痫发生率为5.36％(56/1044),各病种发生率分别为蛛网膜下腔出血19.35％(12/62),脑出血4.33％(19/440),脑梗塞4.61％(25/542)(其中脑栓塞9.09％,脑血栓形成3.99％,P<0.05)。82.1％的癫痫于发病内两周后发作。癫痫发作的类型蛛网膜下腔出血大部为全身性发作,脑出血和脑梗塞以部分性发作为主。除蛛网膜下腔出血外,癫痫发作与病变部位有关,脑血栓形成患者可能与病变大小有关。脑出血和脑梗塞合并癫痫一月内死亡率较未合并癫痫者死亡率高。结论:急性脑血管病继发癫痫发生率为5.36％,多数于病后两周内发生,发生率以蛛网膜下腔出血较高。癫痫发作与病变部位有关,累及皮层或邻近皮层者为多,可能与病变大小有关。合并癫痫的脑血管病患者急性期死亡率较高。     

急性脑出血致脑心综合征的交感神经皮肤反应及动态心电图研究

目的 探讨急性脑出血致脑心综合征的交感神经皮肤反应及动态心电图的改变及临床意义.方法 对38例急性脑出血患者行交感神经皮肤反应(SSR)及动态心电图(DCG)检查,并与20例健康志愿者进行对照.结果 急性期心电图改变类型最常见的为ST-T改变,幕上及幕下出血异常率分别为71.4%、94.1%;其次为心律失常,幕上及幕下出血异常率分别为61.9%、94.1%.脑心综合征组在急性期SSR与对照组比较,差异有统计学意义(P＜0.01),急性期SSR主要表现为潜伏期延长、波幅降低或波形缺失,与对照组比较差异有统计学意义(P＜0.01),其中脑心综合征组中幕上出血患者的SSR双侧异常率为33.3%,单侧为52.4%,单侧异常更显著(P＜0.05);幕下出血SSR双侧异常率为52.4%,单侧为23.5%,单侧异常更显著(P＜0.01).结论 急性脑出血致脑心综合征患者SSR及心电图异常发生率较高,对其测定可能有助于脑心综合征的诊治及病情的判断.     

急性脑血管病神经元特异性烯醇化酶的测定及其临床意义

目的　探讨急性脑血管病患者血清神经元特异性烯醇化酶 (NSE)浓度的变化及其临床意义。方法　应用酶联免疫分析法测定 5 0例急性脑血管病患者和 2 0例正常人血清NSE浓度。病例组包括脑出血2 0例、脑梗死 2 0例、蛛网膜下腔出血 10例。应用直线相关分析方法分析NSE浓度与病灶大小、病情严重程度以及预后的关系。结果　对照组的NSE浓度为 6 .14± 4 .39μg/L。脑出血组NSE浓度为36 .30± 2 4 .5 9μg/L ;脑梗死组NSE浓度为34.95± 2 2 .88μg/L ;蛛网膜下腔出血组NSE浓度为33.4 8± 10 .79μg/L。病例组与对照组之间存在明显的统计学差异 (P <0 .0 1) ,患者组之间无明显统计学差异 (P >0 .0 5 )。NSE浓度与病变的大小、病情严重程度 (GCS评分 )和预后 (GOS评分 )之间存在相关性 (P <0 .0 1)。结论　急性脑血管病患者血清NSE浓度明显增高 ,NSE浓度的高低不仅为神经元损伤程度提供定量信息 ,而且也是判断病情、评估预后的重要参数。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Origins of the sympathetic innervation of the cervical end of the uterus in the rat

A retrograde neuronal tracer (Fast Blue) was injected in the cervical end of the uterine horn of virgin rats. The majority of the retrogradely labeled post-ganglionic sympathetic neurons were found in the sympathetic chain (74%). The superior mesenteric ganglia, inferior mesenteric ganglia and suprarenal ganglia accounted for 22, 3 and <1%, respectively. The distribution of neurons in the sympathetic chain labeled from the uterus resembles that described for other pelvic organs.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Topographical organization of the motoneuron pools that innervate the muscles of the pinna of the cat

The topographical organization of the 22 motoneuron pools that innervate the pinna muscles of the cat was examined by injecting the B-subunit of cholera toxin conjugated to horseradish peroxidase into individual muscles. All 22 pools are found in the facial nucleus, organized as rostro-caudally oriented columns, and arranged according to the action of the muscles they innervate. Pools innervating muscles that pull the pinna dorsally are located in the dorsal two thirds of the medio-dorsal subdivision, and those innervating muscles that pull the pinna ventrally are located in the ventral one half of the nucleus. Motoneurons innervating muscles that pull the pinna cranially are located laterally, those that pull the pinna caudally are located medio-ventrally, and those that change the shape of the pinna are located along the entire dorso-ventral extent in the center of the medio-dorsal subdivision. This topographical layout is consistent with the somatotopic organization of the entire facial nucleus as demonstrated in a variety of species. © 1995 Wiley-Liss, Inc.     

Histochemical methods for the further characterisation of the tumourettes of the posterior lobe of the pituitary

Summary The granular cell tumourettes of the posterior lobe of the pituitary possess neuraminic acid containing carbohydrate. After removal of neuraminic acid with neuraminidase and exposure to FITC (Fluorescein isothiocyanate) labelled peanut agglutinin (Arachis hypogaea) (PNA), intracellular receptor structures could be demonstrated. The significance of the findings is discussed.